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2017 Heath Insurance Rate Summary
Individual and Small Group Markets
September 30, 2016
updated
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Contents
Introduction .................................................................................................................... 2
Urgent Need for Individual Market Reform .................................................................. 2
Minnesota’s Health Insurance Landscape ................................................................... 2
Minnesota’s Uninsured Rate Is at an All-Time Low ................................................. 3
Where Do Minnesotan’s Get Their Health Insurance? ............................................ 4
Small Group Market ....................................................................................................... 4
Minnesota Small Group Health Insurance Policies - 2017 Average Rate Changes . 5
Individual Market............................................................................................................ 6
Minnesota Individual Health Insurance Policies - 2017 Average Rate Changes ...... 6
Essential Health Benefits - Comprehensive Coverage for All ..................................... 8
Metal Levels – A Consumer-Friendly Way to Compare Plans ..................................... 8
Benchmark Plans ........................................................................................................... 9
2017 Benchmark Plans with Monthly Premium for Age 40 Individual ................ 10
Open Enrollment - Shop, Compare and Choose Early ............................................... 11
What is a Rating Area? ................................................................................................. 11
Rating Areas ............................................................................................................. 13
Insurers in Each County with Actively Marketed Plans .......................................... 14
Number of Actively Marketed Plans Per County .................................................... 15
Frequently Asked Questions - Health Insurance Rate Review .................................. 16
In accordance with the Americans with Disabilities Act, this information is available in alternative
forms of communication upon request by calling 651-539-1500.
In accordance with the Americans with Disabilities Act, this information is available in alternative
forms of communication upon request by calling 651-539-1500.
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Introduction
On behalf of Minnesota consumers, the Minnesota Department of Commerce
carefully reviews proposed health insurance rates and plans submitted by insurance
companies to ensure that the rates and policies comply with state and federal law as
well as actuarial standards.
The Department has completed its review for 2017 individual and small group health
insurance policies that will be available during the annual open enrollment period
from November 1, 2016, through January 31, 2017.
The individual market rates apply to about five percent of Minnesotans, who
purchase health insurance on their own through MNsure, an insurance broker/agent
or directly from an insurer. The small group market also includes about five percent
of Minnesotans, with plans that offer health insurance coverage to businesses with
two to 50 full-time employees.
Urgent Need for Individual Market Reform
Minnesota’s individual health insurance market is experiencing serious disruptions in
2017. The dramatic rate increases facing Minnesotans who purchase their own
health insurance are unsustainable and unfair. The rate review process is limited in
its ability to address the market dynamics underlying these trends and
developments. As a result, there is an urgent need for reform.
Governor Dayton recently announced that he will reconvene the Minnesota Task
Force on Health Care Financing to make recommendations to ensure that
Minnesotans have access to affordable, high-quality health insurance options in the
individual market.
Minnesota has long been a national leader and innovator on health care reform. The
challenge and opportunity now is to continue this innovative leadership by reforming
the individual market.
Minnesota’s Health Insurance Landscape
According to the U.S. Census Bureau, the percentage of Minnesotans without health
insurance coverage has reached an all-time historic low level of 4.5 percent – less
than half the national uninsured rate of 9.1 percent. Minnesota’s uninsured
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population has declined dramatically in recent years, with many more Minnesotans
having vital access to the benefits and security of health insurance coverage.
Minnesota’s Uninsured Rate Is at an All-Time Low
Percentage of Uninsured Minnesotans
Most Minnesotans continue to receive their health insurance coverage through
employer-based plans. These include plans that an employer purchases from an
insurance company to cover employees. They also include plans that are self-funded
– generally, a large employer that accepts direct financial liability for the costs of
claims (though enrollment, claims processing and other operations may still be
administered by an insurance company).
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Many other Minnesotans receive their coverage through public programs such as
Medicare, Medicaid and MinnesotaCare.
Medicare is the federal health insurance program for people who are 65 or
older, as well as for certain younger people with disabilities and people with
End-Stage Renal Disease.
Medicaid (known in Minnesota as Medical Assistance) is a joint federal-state
program that helps with medical costs for people with low incomes.
MinnesotaCare is a subsidized premium-based program for lower-income
Minnesotans who do not qualify for Medicaid and do not have access to
affordable insurance coverage.
Where Do Minnesotan’s Get Their Health Insurance?
Small Group Market
Small group health plans are designed to provide coverage for businesses with two to
50 full-time employees. They are sold both through MNsure and directly by insurance
companies and broker/agents. About five percent (or 250,000) of all Minnesotans
receive coverage through small group plans.
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Ten companies are approved to sell small group health policies in 2017:
Blue Cross and Blue Shield of Minnesota
Blue Plus
Federated Mutual Insurance Company
Gundersen Health Plan Minnesota
HealthPartners Inc.
HealthPartners Insurance Company
Medica Insurance Company
PreferredOne Community Health Plan
PreferredOne Insurance Company
Sanford Health Plan
The final rate changes for 2017 plans offered by companies in Minnesota’s small
group market range from a decrease of 1.0 percent to an increase of 17.8 percent.
Most of the rate increases for 2017 are in the single digits. These rate increases
largely reflect the general rise in costs for medical services and prescription drugs.
Each insurance company’s final average rate change is listed in the table below.
Minnesota Small Group Health Insurance Policies - 2017
Average Rate Changes
Company Name 2017 Average Change
BCBSM Inc 14.80%
Blue Plus 12.10%
Federated Mutual Ins Co 17.80%
Gunderson HP MN 8.11%
Healthpartners Inc 6.00%
Healthpartners Ins Co 7.20%
Medica Ins Co 0.56%
PreferredOne Community Health Plan -1.00%
PreferredOne Ins Co 6.00%
Sanford Health Plan 7.00%
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Individual Market
The individual market for health insurance is available for Minnesotans who do not
have access to employer-based coverage and are not eligible for coverage through
public programs like Medicare, Medicaid and MinnesotaCare. About five percent (or
250,000) of all Minnesotans currently purchase their health insurance on the
individual market.
Seven companies are approved to sell health insurance plans to Minnesotans in
2017 in the individual market.
Blue Plus
Group Health, Inc.
HealthPartners Insurance Company
Medica Health Plans of Wisconsin
Medica Insurance Company
PreferredOne Insurance Company
UCare
Consumers will be able to purchase individual market insurance plans either through
MNsure or directly from the insurance companies or insurance broker/agents.
The final rate increases for 2017 plans offered by companies in Minnesota’s
individual market range from 50 percent to 66.8 percent. Each insurance company’s
final average rate increase is listed in the table below.
Minnesota Individual Health Insurance Policies - 2017 Average
Rate Changes
Company Name 2017 Average Change
Blue Plus 55.00%
Group Health 53.00%
HealthPartners 50.00%
Medica Ins Co 57.50%
Medica Health Plans of WI 59.40%
PreferredOne 63.00%
Ucare 66.80%
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Many Minnesotans who purchase individual policies through MNsure will be eligible
for federal tax credits that immediately lower their monthly premiums and help offset
the impact of rate increases. Eligibility for the tax credits is automatically determined
when applying to purchase a plan through MNsure. Four companies – Blue Plus,
HealthPartners, Medica Health Plans of Wisconsin and UCare.
Some key factors that insurance companies cite for their rate increases in
Minnesota’s individual market include:
A higher percentage of less healthy, more costly enrollees than expected are in
the individual market.
Insurers incurred significantly higher claims than expected for medical care
and prescription drugs, especially high-cost specialty drugs.
Minnesota has a relatively small individual market compared to other states,
resulting in a smaller risk pool across which insurers can spread their costs
and pushing up rates for everyone in the individual market.
The federal reinsurance program is ending in 2016 and will no longer provide
funds to insurers in 2017 to stabilize premiums by helping to offset high-cost
claims.
Citing ongoing financial losses, Blue Cross and Blue Shield of Minnesota announced
in late June 2016 that it would leave the individual market in 2017, except for its
Blue Plus HMO affiliate. The company’s decision affects approximately 103,000
Minnesotans who currently have Blue Cross individual policies. This number
represents about 40 percent of the state’s total individual market.
Some insurers are also modifying their service areas and networks in 2017, which
will affect the specific plans available to some consumers.
In addition, each insurer (except Blue Plus) will be limiting its total 2017 enrollment
in order to manage its financial or provider network capacity to absorb the large
number of consumers who will be shopping for new plans, especially current Blue
Cross enrollees who must find a new insurer for 2017.
Even with the discontinued policies and capacity limits, every Minnesotan who needs
to will be able to find an insurance plan in the individual market in 2017, though not
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necessarily the specific insurer or provider network they prefer. To have the best
choice, it is important for consumers to shop, compare and make a plan selection as
early as possible once the open enrollment period begins on November 1, 2016.
Essential Health Benefits - Comprehensive Coverage for All
Starting in 2014, the Affordable Care Act requires that all health plans offered in the
individual and small group markets provide a comprehensive package of items and
services, known as “essential health benefits.” No matter what plan you choose, you
will have standardized coverage for these essential health benefits – with no dollar
limits on the coverage.
The essential health benefits are designed to protect consumers and provide a basic
level of coverage in 10 categories of benefits:
1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health
treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices (services and devices to
help people with injuries, disabilities or chronic conditions gain or recover
mental and physical skills)
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric dental and vision services (sometimes offered through a separate
plan).
Metal Levels – A Consumer-Friendly Way to Compare Plans
Minnesota consumers have the option to choose from four categories of health
insurance plans in the individual market. These are known as “metal levels” –
bronze, silver, gold and platinum.
The difference in the metal levels is the percentage of average overall costs paid by
the insurance company versus the consumer. If you choose a plan at a higher metal
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level, you will pay a higher monthly premium – but will be at risk for lower out-of-
pocket costs in deductibles and copayments.
Bronze – the plan covers 60% of expected costs
Silver – the plan covers 70% of expected costs
Gold – the plan covers 80% of expected costs
Platinum – the plan covers 90% of expected costs
Benchmark Plans
The second-lowest priced silver plan available through MNsure for a given geographic
area is called the “benchmark plan.”
The price of this benchmark plan is used to calculate the federal tax credit that
reduces monthly premiums for eligible individuals and families. (The tax credit
amount is adjusted in relation to the allowable percentage of the consumer’s
income.)
Consumers who are eligible for the federal tax credits are not required to purchase
the benchmark plan in their area and they will not lose out on these credits by
choosing a different plan. However, a plan must be purchased through MNsure in
order to receive the tax credit. When applying to purchase a plan through MNsure,
eligibility for the tax credit is automatically determined, as is eligibility for Medicaid
and Minnesota Care.
Benchmark plans and prices will vary depending on the rating area and plan
availability. The map on the next page shows what insurer has the benchmark plan in
each county, and the monthly premium for an age 40 individual.
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2017 Benchmark Plans with Monthly Premium for Age 40 Individual
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Open Enrollment - Shop, Compare and Choose Early
Minnesotans can purchase their individual health insurance plans during the annual
open enrollment period, which begins on November 1, 2016, and continues through
January 31, 2017. Insurance companies, insurance agents and MNsure will have
specific plan information available for consumers in October.
Every county will have at least two insurers with multiple plan options. Because of the
insurers’ capacity limits, Minnesotans should shop and make their selection early to
have the most options available. Compare insurance plans to find the one that offers
the best value for your health needs and budget. For continuity of care, carefully
review the provider networks offered by plans to see what doctors, clinics and
hospitals are included. If you depend on specific prescription drugs, review the plan’s
drug formulary.
Minnesotans should go to the MNsure website (mnsure.org) to see if they are eligible
for federal tax credits that automatically reduce monthly premiums. The tax credits
are available only for policies purchased through MNsure. People with incomes up to
400 percent of the federal poverty level are eligible. In 2017, the top income
threshold for tax credits is $47,520 for an individual and $97,200 for a family of
four.
What is a Rating Area?
Federal regulations have standardized the factors that insurers are allowed to use
when calculating health insurance premiums for consumers in the individual and
small group markets. Under these regulations, insurers may only use family size, age,
tobacco use and area of residence (rating area) when setting premium rates.
Each state is divided into rating areas, which are used by insurers to set the health
insurance premiums for people who live in the counties in an area. Minnesota has
nine rating areas.
Insurers are required to calculate their rates based on their projected costs in the
specific rating area. These costs may reflect factors such as expected health care
provider expenses in the specific rating area.
When insurance companies calculate their premiums, all households within a rating
area will have the same geographic adjustment factor applied. This means that
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households with similar size, age and tobacco use characteristics buying the same
plan will pay the same premium amounts. Depending on the rating area you live in,
the premium you pay may be higher or lower than the state average.
Insurers are not required to offer their plans on a statewide basis. Specific insurers
and specific plans may be available in some rating areas but not in others. (There
may sometimes also be variation among counties within a rating area.) Depending on
what rating area you live in, you may have more or fewer plan options.
Area 1 Area 2 Area 3 Area 4
Dodge
Fillmore
Freeborn
Goodhue
Houston
Mower
Olmsted
Steele
Wabasha
Winona
Carlton
Cook
Itasca
Koochiching
Lake
Lake of the Woods
St. Louis
Blue Earth
Faribault
Waseca
Le Sueur
Martin
Nicollet
Rice
Watonwan
Brown
Cottonwood
Jackson
Lincoln
Murray
Nobles
Pipestone
Redwood
Rock
Area 5 Area 6 Area 7 Area 8 Area 9
Big Stone
Chippewa
Kandiyohi
Lac Qui Parle
Lyon
McLeod
Meeker
Renville
Sibley
Swift
Yellow
Medicine
Becker
Clay
Douglas
Grant
Otter Tail
Pope
Stevens
Traverse
Wilkin
Aitkin
Beltrami
Cass
Chisago
Crow Wing
Hubbard
Isanti
Kanabec
Mille Lacs
Morrison
Pine
Roseau
Todd
Wadena
Anoka
Benton
Carver
Dakota
Hennepin
Ramsey
Scott
Sherburne
Stearns
Washington
Wright
Clearwater
Kittson
Mahnomen
Marshall
Norman
Pennington
Polk
Red Lake
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Rating Areas
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Insurers in Each County with Actively Marketed Plans
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Number of Actively Marketed Plans Per County
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Frequently Asked Questions - Health Insurance Rate Review
What is an "effective" rate review program?
Minnesota has been designated by the federal government as a state with an
effective rate review program. This means that all proposed rate increases are
scrutinized by expert actuaries in the public interest to make sure the rates comply
with appropriate state and federal laws as well as actuarial standards.
The rate review evaluates the assumptions and information used by health insurers
to develop their rates. Rates must be based on the value of the benefits that
consumers receive for their premiums. Rate review also evaluates whether insurance
companies will be able to pay the expected medical claims costs and fulfill their
financial obligations to the consumers who purchase their policies.
How does an "effective" rate review system operate?
Under federal requirements, an effective rate review system must do the
following:
Receive sufficient data and documentation concerning rate increases to
conduct an examination of reasonableness of the proposed increases.
Consider the factors below as they apply to the rates:
o Medical cost trend changes by major service categories
o Changes in utilization of services (i.e., hospital care, pharmaceuticals,
doctors’ office visits) by major service categories
o Cost-sharing changes by major service categories
o Changes in benefits
o Changes in enrollee risk profile
o Impact of over- or under-estimate of medical trend in previous years on
the current rate
o Reserve needs
o Administrative costs related to programs that improve health care quality
o Other administrative costs related to programs that improve health care
quality
o Other administrative costs
o Applicable taxes and licensing or regulatory fees
o Medical loss ratio
o The impacts of geographic factors and variations
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o The impact of changes within a single risk pool to all products or plans
within the risk pool; and
o The impact of risk adjustment payments and charges.
Make a determination of reasonableness of the rate increase under a standard
set forth in state statute or regulation.
Post all rate filings on their websites or post a link to the preliminary
justifications that appear on the federal RateReview.Healthcare.gov website.
Provide a mechanism for receiving public comments on proposed rate
increases.
Report results of rate review to the Centers for Medicare & Medicaid Services
(CMS) for rate increases subject to review.
Who reviews the rates?
Health insurance rates are reviewed by the experts in the actuarial unit at the
Minnesota Department of Commerce. The Commerce Department also reviews the
rates submitted by Health Maintenance Organizations (HMOs) under an interagency
agreement with the Minnesota Department of Health.
Must health insurance companies submit rate filings each year?
Yes.
What plans are reviewed?
All health insurance rates must be approved by the Minnesota Department of
Commerce or the Minnesota Department of Health prior to becoming effective, as
required in Minnesota Statute section 62A.02.
Self-insured health plans (generally provided by larger employers) are not regulated
by the state.
What is the difference between “rate” and “premium”?
The terms “rate” and “premium” are often used interchangeably when discussing
insurance. However, those terms represent two different things.
Rate: A rate is the average that an insurance company charges for a defined package
of health insurance plans. For example, the rate for your insurance might be $300
per person per month.
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Premium: The amount that you pay for health insurance. For example, if a plan
covers five people at a rate of $300 per person per month, the premium is $1,500
per month.
How often can premiums go up?
In 2014 and later, rates for individual health plans will change once a year, on
January 1. Rates for small employer group coverage can change on a quarterly, semi-
annual or annual basis.
What factors affect rates?
Individual and small group rates are based on a particular plan of benefits with a
particular network of doctors and hospitals based on the combined medical costs of
everyone in that company’s market for a particular age, tobacco use and geographic
area. This is called “adjusted community rating” – the rates are based on the costs of
the entire community (geographic rating area).
The rising costs of medical care and prescription drugs affect rates. With community
rating, your premium may go up even if you have not received any medical services,
because the average cost of medical care and prescription drugs has increased.
What factors affect my premiums?
In general, how much a health plan company charges depends on the following:
Your age and the age of any family members in your plan;
Whether or not each person 18 or older uses tobacco;
Where you live; and
The benefits and network of providers in the plan.
Your premium cannot be based on whether you have a preexisting health condition.
Why did my health insurance premiums go up when I didn’t have any claims (didn’t see a doctor, go to the hospital or get any prescriptions)?
Your premium will not go up solely because you have claims, just as it will not go
down solely because you do not have claims.
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Insurance is a pooling of risks, so individuals pay a share of the pooled experience in
exchange for not assuming the full risk of their own medical costs.
If you have an individual or small group policy, your premium is based on the claims
of everyone in your market. If you have coverage under a large employer health plan,
your premium is based in part on the claims of everyone in the employer group.
How do insurance companies develop rates?
Companies develop rates using estimates of future claim costs, administrative
expenses and how much reserves they need to hold. Rates cannot be based on
recovering financial losses from previous years, though past experience will inform
rate-setting in future years.
Claim costs: The amount an insurer expects to pay for health care services and
goods, such as physician services, hospital fees and prescription drugs, on
behalf of all policyholders with similar policies.
Administrative expenses: The cost of running a health plan. These costs can
typically include:
o salaries of employees;
o costs to maintain computer systems to pay claims;
o costs to manage the provider network (for example, signing up doctors,
hospitals and pharmacies);
o commissions for agents and brokers (called “producers”);
o rent;
o taxes, fees, and assessments that health plans pay to the State or
federal government; and
o other costs to administer the policy (for example, fraud detection and
prevention activities).
Contribution to reserves and profit: Money that an insurance company has left
after paying for claims and administrative expenses. The reserves are needed
to pay for claims and administrative expenses in years when the insurers do
not collect enough premiums to cover those costs, or when claims for the
current year are submitted late.
What do you consider when reviewing a rate request?
All health plan rate filings must meet these criteria:
Anticipated loss ratio meets the state's minimum of 71% to 82%;
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Rates are sufficient to cover expected claims and expenses;
Rates provide a reasonable value to the insured; and
The filing is complete, correct, and understandable.
In order to demonstrate that the above criteria are met, the filing must include at
least the following information:
Historical information, such as date of issue, any changes in benefits, rates, or
profitability;
Historical experience including premiums, claims and enrollment;
Statistical reliability of historical experience;
Assumptions used in projecting the future loss ratio– anticipated changes in
claim cost per person and enrollment. The reasons for a rate increase, such as
benefit changes, population changes, tax and fee changes.
How does the Commerce Department decide whether to approve or object to a requested rate change?
Approved - If the filing is clear and justifies the filed rates, the filing is approved and
the company is notified that the rates may be used.
Objection - If the information in the filing is not clear or does not justify the filed rates
or rate increase, the Department of Commerce sends an objection letter to the filing
company.
Do rate changes always get approved?
No. A decision is made for each filing as to whether the rate is approved or not
approved.
What if the insurance company disagrees with the decision?
The company can request a hearing, and have a judge decide whether the
Department's decision not to approve a filing was reasonable or unreasonable.
What is the public’s role in the rate review process?
Beginning in 2015 for plan year 2016, the Minnesota public has access to
information submitted by insurance companies for their plans with proposed rate
increases. This information is posted on the federal RateReview.Healthcare.gov
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website. Minnesotans also have the opportunity to submit comments to the
Commerce Department about the rate proposals.
As part of the Commerce Department’s rate review process, Minnesotans may
submit public comments on proposed rate increases by e-mail to
Who can I contact if I have questions about the rate review process?
You can contact the Department of Commerce Consumer Services Center by email at
[email protected] or by phone at 651-539-1600 or 800-657-3602
(Greater Minnesota).
